We have previously reported the clinical use- fulness of 99m Tc-HYNIC-tir-octreotide (TOC) in patients with rheumatological diseases 3 . Here we report the case of a 59 year old woman affected by lung and joint sarcoidosis and secondary SS, successfully treated with infliximab and methotrexate, where 99m Tc-HYNIC- TOC scintig- raphy was useful in diagnosis, choice of treat- ment and follow-up. Case Report A 59 year old woman was referred to our clin- ic in November 2004 for diffuse joint pain, per- sistent cough, xerostomia and xerophtalmia. Joint pain started in 2003, localized at the left wrist, and then rapidly spreading to many other di- arthrodial joints. Laboratory findings showed presence of antinuclear antibodies (ANA) with speckled pattern at low titre (1:80), high levels of circulating immunocomplexes, polyclonal hyper- gammaglobulinemia, elevated levels of erythro- cyte sedimentation rate (ESR), CRP and rheuma- toid factor, while anti citrullinated-peptide anti- bodies and anti ENA antibodies were unde- tectable. Schirmer’s test and functional salivary gland scintigraphy showed a decrease in exocrine glands function; ultrasonographic study of parotid glands showed a typical chronic inflam- matory pattern, without isolated neoformations in the contest of gland parenchyma, fully compati- 127 Abstract. – We report the case of a 59 years old woman affected by lung and joint sar- coidosis, secondary Sjogren’s syndrome refrac- tory to common disease-modifying antirheumat- ic drugs (DMARDs) that regressed with inflix- imab and methotrexate. 99m Tc-HYNIC- TOC scintigraphy was useful in diagnosis, choice of treatment and follow-up. Key Words: Sarcoidosis, Sjogren, Octreotide, TNF-alpha, Inflix- imab. Introduction Sarcoidosis is a multisystem disease of un- known aetiology. Histological evidence of non- caseating granulomas represents the main find- ing. Sjogren’s syndrome (SS) is a chronic au- toimmune disease affecting the exocrine glands, primarily the salivary and lacrimal glands. SS can be secondary to many other au- toimmune and non-autoimmune diseases, like rheumathoid arthritis, systemic lupus erythe- matosus (SLE), Hashimoto’s thyroiditis, neo- plasia, sarcoidosis 1 . It is known that chronically inflamed tissues overexpress the receptor for somatostatin (SSR) 2 . European Review for Medical and Pharmacological Sciences 2008; 12: 127-130 Corresponding Author: A. Migliore, MD; e-mail: albertomigliore@terra.es Relevance of 99m Tc-HYNIC-tir-octreotide scintigraphy in a patient affected by sarcoidosis with lung and joints involvement and secondary Sjogren’s syndrome treated with infliximab Case report A. MIGLIORE 1 , A. SIGNORE 2,4 , A. CAPUANO 1 , E. BIZZI 1 , U. MASSAFRA 1 , F. VACCA 1 , V. TODINO 2 , M. CHIANELLI 3,4 1 UOS of Rheumatology, Fatebenefratelli, S. Pietro Hospital, Rome (Italy) 2 Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, (The Netherlands) 3 Nuclear Medicine Department, Regina Apostolorum Hospital, Albano, Rome (Italy) 4 Nuclear Medicine Department, S. Andrea Hospital, 2nd Medical School, University La Sapienza, Rome (Italy)